Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
US Oncology Network, Virginia Cancer Specialists, Arlington, VA, USA.
Curr Oncol Rep. 2019 Nov 28;21(12):109. doi: 10.1007/s11912-019-0848-5.
One year of trastuzumab dramatically improves outcomes in early HER2 positive breast cancer, irrespective of anatomic stage, receptor status and chemotherapy backbone. However, up to 25% of breast cancers treated with trastuzumab and chemotherapy recur. Here, we review the current role for additional HER2 blockade to adjuvant trastuzumab.
Adjuvant pertuzumab and neratinib modestly improve disease-free survival in early breast cancer, particularly for those at highest risk of recurrence. Lack of complete pathologic response to preoperative chemotherapy and HER2 targeted therapies is associated with worse outcomes. In those with lack of pCR, adjuvant trastuzumab emtansine improves outcome in early breast cancer, irrespective of chemotherapy and HER2 targeted therapy backbone. Preoperative chemotherapy and HER2 targeted therapy should be discussed in early breast cancer, especially in tumors over 2 cm. Future trials must focus on de-escalation of chemotherapy and biomarkers for further tailored therapy in early HER2 positive breast cancer.
曲妥珠单抗治疗可显著改善早期 HER2 阳性乳腺癌患者的预后，无论解剖分期、受体状态和化疗方案如何。然而，多达 25%的接受曲妥珠单抗和化疗治疗的乳腺癌会复发。在这里，我们回顾了辅助曲妥珠单抗治疗中曲妥珠单抗的额外作用。
辅助帕妥珠单抗和奈拉替尼可适度改善早期乳腺癌的无病生存率，特别是对复发风险最高的患者。术前化疗和曲妥珠单抗靶向治疗无完全病理缓解与较差的预后相关。在那些没有 pCR 的患者中，辅助曲妥珠单抗-美坦新可改善早期乳腺癌的预后，无论化疗和曲妥珠单抗靶向治疗方案如何。早期乳腺癌应考虑术前化疗和曲妥珠单抗靶向治疗，特别是肿瘤大于 2cm 的患者。未来的临床试验必须集中于降低化疗强度，并寻找早期 HER2 阳性乳腺癌进一步靶向治疗的生物标志物。
